Awadzi K, Addy E T, Opoku N O, Plenge-Bönig A, Büttner D W
Onchocerciasis Chemotherapy Research Centre, Hohoe, Ghana.
Trop Med Parasitol. 1995 Dec;46(4):213-20.
Ivermectin is a potent microfilaricide that also blocks microfilarial release while albendazole is toxic to all intrauterine stages. We investigated whether their combination would permanently sterilize the adult worms. In the first open phase, all 69 patients received 150 micrograms/kg of ivermectin. In the second double-blind phase one week later, 35 patients were randomized to receive 800 mg of albendazole with a fatty breakfast for three consecutive days while 34 patients received matching placebo tablets. Detailed clinical and laboratory examinations were done before treatment and were repeated at intervals over one year. Nodules were excised at three and six months. There was a rapid reduction in skin microfilariae, maximal at four weeks (99.9%). Counts increased subsequently and were between 11 and 18% of initial values at one year. Nodule histology showed no macrofilaricidal activity of the combination. A high proportion of the stretched intrauterine microfilariae were degenerate in both groups. Anterior chamber microfilarial counts were unchanged until day 18 and then fell successively. Low levels persisted in several patients at one year. Dead corneal microfilariae and corneal punctate opacities increased initially, fell with time and then disappeared in most patients. Systemic and ocular reactions were mild to moderate and biochemical abnormalities were minor. A pronounced posttreatment eosinophilia subsided by day 30. There was no significant difference between the two groups in clinical and laboratory tolerance or in alterations in skin and ocular parasites and no important differences in the effect on the adult worms. The combination of ivermectin with albendazole given one week apart is well tolerated but produces no additional effect against Onchocerca volvulus when compared to ivermectin given alone.
伊维菌素是一种有效的杀微丝蚴剂，还能阻止微丝蚴释放，而阿苯达唑对所有子宫内阶段的寄生虫均有毒性。我们研究了二者联合使用是否会使成虫永久绝育。在首个开放阶段，所有69名患者均接受了150微克/千克的伊维菌素治疗。一周后的第二个双盲阶段，35名患者被随机分配连续三天在食用高脂早餐的同时服用800毫克阿苯达唑治疗，而34名患者则服用匹配外观的安慰剂片。在治疗前进行了详细的临床和实验室检查，并在一年期间定期重复检查这些项目。在三个月和六个月时切除结节。皮肤微丝蚴数量迅速减少，四周时达到最大值（99.9%）随后数量增加，并在一年时降至初始值的11%至18%之间。结节组织学显示联合用药无杀成虫活性。两组中大部分伸展于子宫内的微丝蚴均已退化。前房微丝蚴数量在第18天前未发生变化，之后逐渐下降。一年时，仍有几名患者的微丝蚴数量维持在较低水平。死亡的角膜微丝蚴及角膜点状混浊最初增加，之后随时间下降并在大多数患者中消失。全身和眼部反应为轻至中度，生化指标异常轻微。治疗后明显的嗜酸性粒细胞增多症在第30天时消退。两组患者在临床和实验室耐受性、皮肤及眼部寄生虫变化方面无显著差异，对成虫的作用也无重要差异分开一周给药的伊维菌素与阿苯达唑联合用药耐受性良好，但与单独使用伊维菌素相比，对盘尾丝虫并无额外疗效。
